1,720,963 research outputs found
Treatment of sleep-related eating disorder
No full textSleep-related eating disorder (SRED) is classified as an NREM-related parasomnia characterized by recurrent episodes of dysfunctional eating that occur after an arousal from the main sleep period with partial or complete amnesia for the event, resulting in weight gain from eating high calorie foods and causing various injuries due to consumption of inedible or toxic items. SRED can be idiopathic or commonly associated with other primary sleep disorders such as sleepwalking, restless legs syndrome (RLS), obstructive sleep apnea syndrome (OSAS), other clinical conditions, or use of sedative-hypnotic medications. First-line treatment of idiopathic SRED includes selective serotonin reuptake inhibitors (SSRIs) at mean dosages of 20 to 30 mg/day. Topiramate at 100-300 mg/day and clonazepam at 0.5-2.0 mg/day can be valid alternative options. SRED related to other parasomnias or sleep disturbances that cause sleep fragmentation benefit most from treatment of the associated sleep disorder. In particular, RLS-related SRED is best treated with dopamine agonists such as pramipexole, while sleepwalking-related SRED benefits from low-dose benzodiazepines such as clonazepam. Different kinds of drug associations have been proposed in a limited number of cases, especially in the past. We strongly recommend that all patients suffering from SRED should undergo consistent and regular follow-up about 2-3 times per year or otherwise according to the physician's judgment, in order to assess the evolution of symptom severity and frequency and re-evaluate treatment efficacy and any side effects that may arise
Diabetes in migrants and ethnic minorities in a changing World
Full text linkOn a worldwide scale, the total number of migrants exceeds 200 million and is not expected to reduce, fuelled by the economic crisis, terrorism and wars, generating increasing clinical and administrative problems to National Health Systems. Chronic non-communicable diseases (NCD), and specifically diabetes, are on the front-line, due to the high number of cases at risk, duration and cost of diseases, and availability of effective measures of prevention and treatment. We reviewed the documents of International Agencies on migration and performed a PubMed search of existing literature, focusing on the differences in the prevalence of diabetes between migrants and native people, the prevalence of NCD in migrants vs rates in the countries of origin, diabetes convergence, risk of diabetes progression and standard of care in migrants. Even in universalistic healthcare systems, differences in socioeconomic status and barriers generated by the present culture of biomedicine make high-risk ethnic minorities under-treated and not protected against inequalities. Underutilization of drugs and primary care services in specific ethnic groups are far from being money-saving, and might produce higher hospitalization rates due to disease progression and complications. Efforts should be made to favor screening and treatment programs, to adapt education programs to specific cultures, and to develop community partnerships
Which treatment for type 2 diabetes associated with non-alcoholic fatty liver disease?
No full textType 2 diabetes (T2DM) and nonalcoholic fatty liver disease (NAFLD) are highly prevalent in the community, and share common pathogenic mechanisms. There is also evidence that T2DM may be favored by hepatic fat accumulation; in turn the presence of T2DM is a risk factor for liver disease progression. The treatment of T2DM has considerably changed in the past few years; new drug classes, promoting glucose-lowering through mechanisms different from classical insulin-sensitizing or insulin-secreting action, have been added to continuing lifestyle intervention. Metformin and pioglitazone may be safely used in the presence of liver fat, whereas sulfonylureas and insulin itself have been associated with NAFLD progression and adverse outcome. Drugs acting on the incretin axis and on Na-glucose co-transport at renal tubular level offer new hopes for a tailored treatment able to reduce the burden of hepatic triglyceride accumulation and liver disease progression
Pathophysiology of Nonalcoholic Fatty Liver Disease: Lifestyle-Gut-Gene Interaction
No full textBackground: The accumulation of fat droplets in the hepatic parenchyma is driven by several factors, synergistically acting to increase triglyceride flow to the liver (diet and metabolic factors, endotoxemia from gut microbiota, genetic factors). Key Messages: In the presence of unhealthy lifestyles and behavioral factors, leading to enlarged adipose tissue and insulin resistance (IR), both lipolysis and de novo lipogenesis are expected to increase the risk of hepatic lipid depots, in association with high calorie (either high-fat or high-carbohydrate) diets. The gut microbiota may also be involved via obesity, IR and hepatic inflammation generated by gut-derived toxic factors. Finally, several data also support a primary role of genetic factors. A few gene polymorphisms have also been associated with the risk of nonalcoholic fatty liver disease development and nonalcoholic steatohepatitis progression to more fibrosis and advanced liver disease. In a few cases (e.g., patatin-like phospholipase domain-containing 3/adiponutrin), steatosis carries a high risk of both liver disease and cardiovascular morbidity/mortality; in other cases (e.g., transmembrane 6 superfamily 2 human gene), dissociation has been observed between the increased risk of liver disease versus cardiovascular disease. Conclusions: A variable interplay between the genetic background and the metabolic milieu is the likely physiopathologic mechanism involved in individual cases, which must be considered for implementing effective treatment strategies
Combination of GLP-1 receptor agonists and behavioural treatment in type 2 diabetes elicits synergistic effects on body weight: A retrospective cohort study
Full text linkIntensification of type 2 diabetes (T2DM) treatment with GLP-1 receptor agonists (GLP-1RAs) promotes weight loss. We aimed to determine the synergistic effect of behavioural programmes on body weight on top of GLP-1RA treatment
Hypnic jerks are an underestimated sleep motor phenomenon in patients with parkinsonism. A video-polysomnographic and neurophysiological study
No full textIntroduction Hypnic jerks (HJs) are sudden contractions of one or more body segments occurring mostly at sleep onset. They are highly sporadic and affect all ages and both sexes with prevalence between 60% and 70% in the general population. Study objectives This study describes the frequency and the neurophysiological characteristics of HJs in a population of patients with parkinsonism by means of nocturnal video-polysomnographic recordings. Methods This is a prospective cohort study and is reported following the STROBE guidelines. We analyzed the clinical and video-polysomnographic data of the first 66 consecutive patients recruited in the ongoing prospective study “Bologna motor and non-motor Prospective study on Parkinsonism at onset” (BoProPark). Each patient underwent a full neurological workup including a whole-night video- polysomnography. Neurophysiological characteristics including the propagation patterns of the HJs were studied with an extended muscle montage polysomnography. Results We recorded a total of 62 HJs in 16 patients out of 66 (24%). Sleep parameters were not statistically different between patients with and without HJs. All HJs were spontaneous and occurred randomly throughout the night. Electromyographic analysis showed that muscle activity arose from different muscles with no prevalence of one over the other and without any ordered propagation. No recurring motor pattern of the jerks was detected. Discussion and conclusions Our findings demonstrated that HJs are a frequent, underestimated, sleep-related motor phenomenon in patients with parkinsonism. As they may represent a further cause of sleep disruption and insomnia, HJs should be actively examined. Neurophysiological analysis suggests a subcortical origin of HJs as shown previously for a healthy subject
Long-term treatment of severe obesity: are lifestyle interventions still an option?
No full textIntroduction: Following lifestyle intervention programs based on dietary restriction and habitual physical activity, weight loss, however large, is reported to peak within six months. Despite maintenance protocols, only few cases continue to lose weight thereafter. The majority of cases regain weight and adherence to lifestyle changes are fostered by long-term contact with a supportive team. In general, surgical procedures are reported to produce much larger weight loss and to impact more favorably on long-term weight loss maintenance. Areas covered: We performed a PubMed search on lifestyle modification studies, focusing on the role of behavior programs for the long-term management of obesity in comparison with surgical procedures. Behaviorally-achieved weight loss outcomes can be improved by integrating standard behavior therapy with self-regulation cognitive skills, motivational interviewing and/or phone/internet-based recall systems. Expert commentary: Clinically-important long-term weight loss is achievable by behavior therapy in a small proportion of subjects with obesity, however severe, through personalized programs associating lifestyle modification interventions, with procedures aimed at developing commitment and responsibility skills. A new area of research is the integration of cognitive-behavior therapy with bariatric (metabolic) surgery, either pre- or post-operatively, to exploit long-term adherence to healthy diet and habitual physical activity
New mineralocorticoid receptor antagonists: update on their use in chronic kidney disease and heart failure
No full textAldosterone is a mineralocorticoid hormone with a well-known effect on the renal tubule leading to water retention and potassium reabsorption. Other major effects of the hormone include the induction of proinflammatory activity that leads to progressive fibrotic damage of the target organs, heart and kidney. Blocking the aldosterone receptor therefore represents an important pharmacological strategy to avoid the clinical conditions deriving from heart failure (CHF) and chronic kidney disease (CKD). However, steroidal mineralocorticoid receptor antagonists (MRA) have a low safety profile, especially in CKD patients due to the high incidence of hyperkalemia. A new generation of nonsteroidal MRA has recently been developed to obtain a selective receptor block avoiding side-effects like hyperkalemia and thereby making the drugs suitable for administration to CKD patients. This review summarizes the results of published preclinical and clinical studies on the nonsteroidal MRA, apararenone esaxerenone and finerenone. The trials showed a better safety profile with maintained drug efficacy compared with steroidal MRA. For this reason, nonsteroidal MRA represent an interesting new therapeutic approach for the prevention of CHF and CKD progression. Some basic research findings also yielded interesting results in acute clinical settings such as myocardial infarction and acute kidney injury
An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers
Full text linkBackground & Aims: Interventions aimed at lifestyle changes are pivotal for the treatment of non-alcoholic fatty liver disease (NAFLD), and web-based programs might help remove barriers in both patients and therapists. Methods: In the period 2010–15, 716 consecutive NAFLD cases (mean age, 52; type 2 diabetes, 33%) were treated in our Department with structured programs. The usual protocol included motivational interviewing and a group-based intervention (GBI), chaired by physicians, dietitians and psychologists (five weekly meetings, n = 438). Individuals who could not attend GBI entered a web-based intervention (WBI, n = 278) derived from GBI, with interactive games, learning tests, motivational tests, and mail contacts with the center. The primary outcome was weight loss ≥10%; secondary outcomes were alanine aminotransferase within normal limits, changes in lifestyle, weight, alanine aminotransferase, and surrogate markers of steatosis and fibrosis. Results: GBI and WBI cohorts had similar body mass index (mean, 33 kg/m2), with more males (67% vs. 45%), younger age, higher education, and more physical activity in the WBI group. The two-year attrition rate was higher in the WBI group. Healthy lifestyle changes were observed in both groups and body mass index decreased by almost two points; the 10% weight target was reached in 20% of WBI cases vs. 15% in GBI (not significant). In logistic regression analysis, after adjustment for confounders and attrition rates, WBI was not associated with a reduction of patients reaching short- and long-term 10% weight targets. Liver enzymes decreased in both groups, and normalized more frequently in WBI. Fatty liver index was reduced, whereas fibrosis remained stable (NAFLD fibrosis score) or similarly decreased (Fib-4). Conclusion: WBI is not less effective than common lifestyle programs, as measured by significant clinical outcomes associated with improved histological outcomes in NAFLD. eHealth programs may effectively contribute to NAFLD control. Lay summary: In patients with non-alcoholic fatty liver disease, participation in structured lifestyle programs may be jeopardized by job and time constraints. A web-based intervention may be better suited for young, busy patients, and for those living far from liver units. The study shows that, following a structured motivational approach, a web-based, interactive intervention coupled with six-month face-to-face meetings is not inferior to a standard group-based intervention with respect to weight loss, adherence to healthy diet and habitual physical activity, normalization of liver enzymes, and stable surrogate markers of fibrosis
Emergency department accesses for diabetes-related complications during COVID-19 pandemic in people with type 2 diabetes and depression
No full textIntroduction
Mental disorders are leading causes of the global health-related burden. In 2020, COVID -19 pandemic has created an environment where many determinants of poor mental health exacerbated. Scientific literature has highlighted that people with diabetes are at higher risk of developing depression than the general population and that depression interferes with the course of diabetes. In fact, depression in type 2 diabetes mellitus (T2DM) increases the risk of developing acute and long-term complications.
The aim is to evaluate whether depression in people with type 2 diabetes increases the number of Emergency Department (ED) accesses for acute and long-term diabetes-related complications during COVID-19 pandemic.
Methods
In this observational cohort study, data were retrospectively retrieved from the health administrative databases of the Local Health Authority of Romagna (about 1.1 million residents), in particular we used: Hospital Discharge Records and Pharmaceutical Prescriptions databases to identify T2DM patients; Mental Health Information System, Residential Mental Health care, HDR and PP databases to identify patients with depression.
Prevalent cases of T2DM at 15/02/2020 were identified among individuals aged 18 years or older, residing in the LHA of Romagna, if they had in the preceding year at least one HDR claim with a primary or secondary diagnosis of diabetes (ICD-9-CM code: 250.xx), or at least two distinct prescriptions of Glucose-Lowering Medication (GLM) (ATC code: A10).
The presence of depression was defined as at least one prescription of antidepressant drugs (ATC code: N06A), or at least one hospitalization/outpatients service with a primary or secondary diagnosis of depression (ICD-9-CM code: 296.2x, 296.3x, 296.9x, 300.4x, 309.0x, 309.1x, 311.xx) in the 10 preceding years. Therefore, patients were distinguished between T2DM with depression (T2DM-Dep) and without depression (T2DM-NoDep).
The cohort was followed up over the next 12 months (until death or 15/02/2021, whichever came first) and the number of ED accesses for acute and long-term complications related to diabetes were investigated.
With the same criteria, a prevalent cohort of T2DM at 15/02/2019 was identified to assess what was the impact of depression in a pre-pandemic period.
The study was conducted according to the guidelines of the Declaration of Helsinki; the Ethics Committee of the Romagna Local Health Authority (C.E.R.O.M.) approved the study procedures (registration number: 9502/2020, 14.12.2020). This retrospective study was carried out in conformity with the regulations on data management with the Italian law on privacy (Legislation Decree 196/2003 amended by Legislation Decree 101/2018).
Statistical analysis
Demographic and clinical characteristics of T2DM-Dep and T2DM-NoDep 2020 prevalent cases were summarized using absolute frequencies and percentages.
The impact of depression on the number of ED accesses was estimated with a multiple negative binomial regression model to calculate the incidence rate ratio (IRR) and its 95% confidence interval. The multiple model was adjusted for gender, age groups (18–39, 40–59, 60–74, > 74 years), drug therapy of the last 5 years (1 oral GLM, 2 or more oral GLM, insulin, insulin and oral GLM), number of comorbidities detected in the two previous years from prevalence date (0, 1, 2 or more comorbidities) and duration of diabetes (< 1, 1–4, 5–9, > 9 years). The number of comorbid conditions was determined for each patient using the Elixhauser algorithm.
The significance level was set at p < 0.05. Statistical analyses were performed using IBM SPSS version 25.0 and Stata 15.
Results
At 15/02/2020 we found 61,887 prevalent cases of T2DM, 28.3% patients were in the T2DM-Dep group and 71.7% in the T2DM-NoDep group. During COVID-19 period 541 ED accesses were observed.
T2DM-Dep patients had a higher rate of ED accesses for acute and long-term complications related to diabetes during COVID-19 pandemic compared to T2DM-NoDep patients (IRR = 1.47; 95% CI [1.18—1.83]), adjusted for gender, age groups, duration of T2DM, drug therapy of the last 5 years, and number of comorbidities.
This significantly different rate of ED accesses was also observed in the prevalent cases of non-pandemic period (n = 60,618; total ED accesses = 659), in which T2DM-Dep patients had an IRR of 1.43 (95% CI [1.18–1.73]) compared to T2DM-NoDep patients, adjusted for clinical and demographic factors.
The higher rate of ED accesses in T2DM-Dep group compared to T2DM-NoDep group was similar between COVID-19 period and the pre-pandemic period (group-period interaction term: IRR = 1.01; 95% CI [0.76–1.34]).
Discussion
The diagnosis of depression in type 2 diabetes is associated with a higher rate of ED accesses for acute and long-term complications, both during the COVID-19 pandemic and in the pre-pandemic period.
Despite the overall decrease in ED access rate during the COVID-19 pandemic ( − 19.6% percentage variation compared to the preceding year) due to the restrictions, a clear difference in ED accesses was observed in patients with T2DM and depression compared to patients with T2DM without depression. This is consistent with evidence on the impact of depression on short-term complications in people with type 2 diabetes and depression. Since COVID-19 is associated with poor mental health, the special health needs of patients with diabetes and depression should be taken into account
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